Gender and HIV/AIDS: Prevention among young people

Students collaborate during an exercise on HIV/AIDS prevention at a school in Barentu, Eritrea.

The face of HIV/AIDS is young and female. In fact, both girls and boys face a number of gender-specific risk factors – many of which are embedded in the social relations and economic realities of their societies. Girls’ and young women’s vulnerability, however, is more severe and translates into significant higher infection rates.

Eastern and Southern Africa(ESA) continues to be the epicentre of the HIV and AIDS epidemic and has the highest number of young HIV-infected people between the ages of 15 and 24 out of all regions . The total number of infected girls and young women that age is more than twice as high as among their male counterparts – 1.9 million compared to 780,000 .

Despite this alarming trend, girls and young women in general terms know less than men about how HIV is transmitted and how it can be prevented. Such average figures on HIV prevalence and prevention knowledge, however, mask significant differences between young women and men from different education and wealth backgrounds – a fact that is increasingly being taken into account in prevention programmes for young people.

Key issues

Fast and Figures: In ESA, the feminization of the HIV epidemic starts at an early age. In Swaziland and Lesotho, for example, the HIV prevalence among adolescent girls aged 15–17 years is more than four times higher than among their male peers (6.2 percent/1.4 percent and 6.1/1.6, respectively). Further analysis reveals that many of these girls have been infected by young men who are at least five years older, which corresponds to the fact that age-disparate relationships are very common in the region.

Studies have shown that girls who engage in such a relationship - often for economic and other material reasons - usually have very limited possibilities to negotiate safe sex. Age-disparate and cross-generational (ten years age difference or more) sexual relationships therefore increase girls’ vulnerability to HIV infection. Demographic and Health Survey data from Swaziland, Uganda, Tanzania and Zimbabwe found a significant association between a young woman’s HIV status and the number and age of her partners. In Swaziland, for instance, a young woman with more than one significantly older partner is three times more likely to be HIV positive.

Once girls and young women enter in a stable relationship, it often becomes difficult for them to insist in condom use. As a result, HIV infection rates among married women are significantly higher than among single women. In Zimbabwe, for example, among females aged 15–24, HIV prevalence ranges from 6.2 percent among women who had never married, up to 14.2 per cent among those currently married or in union up to 26 percent among those divorced or widowed .

Gender norms and related risks: Cultural values and gender norms, which result in gender inequality, are widespread throughout the region and contribute significantly to young people’s vulnerability to HIV infection and to the spread of the disease. These gender norms define masculinity and femininity and shape gender relations.

Norms and expectations of masculinity and male behaviour increase men’s and boys’ risk of acquiring HIV and other sexually transmitted infections. Men and boys are encouraged to have multiple sexual partners while older men seek out sexual relations with younger women. Homophobia stigmatizes men who have sex with other men, and makes them and their partners vulnerable to HIV.

Girls dance during a 'Young People We Care' (YPWC) meeting at the secondary school in Zimbabwe.

Conversely, norms related to femininity deny women sexual health knowledge and prevent them from controlling their bodies or deciding the terms on which they have sex. Compounding women’s vulnerability is their limited access to economic opportunities and autonomy, and the multiple household and community roles they are saddled with.

Violence against women: There is also a strong correlation between sexual and gender-based violence and a woman's risk of contracting HIV. Vulnerability to HIV infection is higher during forced or coercive sex due to the increased chance of vaginal tearing, especially in younger women whose vaginas are not mature. In Zimbabwe, 25 percent of all women have experienced sexual violence at some point in their lives. A UNICEF study in Swaziland found that one in four women experienced sexual violence as a child and two out of three women 18–24 years old had experienced sexual violence. The women’s boyfriends and husbands were the most frequent abusers. The fear of intimate partner violence also prevents many women from asking their partners to use condoms, obtaining information on HIV prevention, and accessing testing and treatment.

Knowledge: Despite important efforts to strengthen HIV prevention education, comprehensive knowledge among young people - which means knowing that consistent use of condoms and having just one uninfected faithful partner can reduce the HIV risk and that a healthy-looking person can be HIV-positive - are still very low in the region. Only in Namibia, Rwanda and Swaziland, more than 50 percent of both young men and women have attained such a level of knowledge .

UNICEF interventions

UNICEF works in partnership with the UN Population Fund (UNFPA), UNESCO and the World Health Organization (WHO) to empower adolescent girls and boys to take informed decision about their sexuality through comprehensive life skills programmes, in many cases integrated into education curricula. These interventions offer young people gender-specific, age-appropriate information on HIV and the steps they can take to prevent infection including delayed sexual debut, correct and consistent condom use, mutual faithfulness, the reduction in age difference between partners as well as in the number of partners, and the use of testing and counselling services for HIV and other sexually transmitted illnesses.

In South Africa, for example, UNICEF is working with the Department of Education and a private company, SuperSport, to minimize the vulnerability of young people to HIV through sports development. UNICEF’s training guide, Coaching Boys to Men, promotes positive masculine behaviour, addressing issues such as gender-based violence. The programme also promotes the participation of young girls in sports, especially soccer.

Building on recent evidence which highlights the vulnerability of older adolescent girls, UNICEF has been developing a specific programme targeting 15 to 17 year olds. The programme is called “Sister to Sister (S2S)” and is currently being rolled out in Malawi, Tanzania, Lesotho and Namibia. It includes intensive 3-day risk reduction education organized in schools, but outside of the normal curriculum. The programme which is facilitated by young women for their peers is based on a set of core modules and aims at behavioural outcomes around multiple concurrent partnerships and age-disparate sex.

A longitudinal study was undertaken during the ‘proof of concept’-phase, and the primary research data has shown significant positive impacts on behaviours from the intervention.